Does looped nasogastric tube feeding improve nutritional delivery for patients with dysphagia after acute stroke? A randomised controlled trial

Abstract

Background: nasogastric tube (NGT) feeding is commonly used after stroke, but its effectiveness is limited by frequent dislodgement. Objective: the objective of the study was to evaluate looped NGT feeding in acute stroke patients with dysphagia. Methods: this was a randomised controlled trial of 104 patients with acute stroke fed by NGT in three UK stroke units. NGT was secured using either a nasal loop (n = 51) or a conventional adhesive dressing (n = 53). The main outcome measure was the proportion of prescribed feed and fluids delivered via NGT in 2 weeks post-randomisation. Secondary outcomes were frequency of NGT insertions, treatment failure, tolerability, adverse events and costs at 2 weeks; mortality; length of hospital stay; residential status; and Barthel Index at 3 months. Results: participants assigned to looped NGT feeding received a mean 17% (95% confidence interval 5-28%) more volume of feed and fluids, required fewer NGTs (median 1 vs 4), and had fewer electrolyte abnormalities than controls. There was more minor nasal trauma in the loop group. There were no differences in outcomes at 3 months. Looped NGT feeding cost £88 more per patient over 2 weeks than controls. Conclusion: looped NGT feeding improves delivery of feed and fluids and reduces NGT reinsertion with little additional cost.

Guideline clinical nutrition in patients with stroke

“…Two studies about nasal loops in stroke patients demonstrated that nasal loops are safe, well tolerated and effective at delivering full enteral nutrition [73,74]. A recent randomized controlled trial observed an increase of 17% mean volume of fluid and tube feed given in the nasal loop group without any differences in outcome after 3 months [74]. …”

Dysphagia: implications for older people

“…[154][155][156] However, placement is not without controversy and further, whilst tube feeding may solve problems around nutritional intake, it does not eliminate problems around aspiration and infection. [154][155][156] However, placement is not without controversy and further, whilst tube feeding may solve problems around nutritional intake, it does not eliminate problems around aspiration and infection.…”

The One-Year Attributable Cost of Post-stroke Dysphagia

“…A literature search of PubMed (August 2013) to ascertain the current state of knowledge on the cost of dysphagia post-stroke yielded 32 articles of which 5 provided data on the cost of an evaluation or intervention [10–14], while 3 provided data on the cost of a diagnosis related to dysphagia (aspiration pneumonia) [15–17]. The majority of the articles (20 of 32) speculated that their findings may have an impact on cost or may be cost effective, or they stated that evaluating cost-effectiveness was an important future goal but did not provide new cost data.…”